Sarah’s Story: Highlighting the Dangers of Delayed Cauda Equina Diagnosis

Case supported by Michael Gray, Partner

In November 2024, Sarah (name changed for privacy), began experiencing escalating neurological pain. What started as a deep ache quickly turned into unbearable, shooting pain from her lower back down to her toes. She couldn’t sit, stand, or even lie down without agony. She described the pain as ‘feeling like labour’.

Fearful, she called NHS 111 and followed their advice to attend A&E. But despite being in hospital for more than 10 hours, needing strong pain relief, and presenting with symptoms suggestive of a spinal emergency, she was sent home with a diagnosis of sciatica.

Crying out for help

The diagnosis meant that Sarah started to doubt herself, and worry that she was being ‘overdramatic’, or as behaving like a ‘wimp’ – as she had personal connections with people who have experienced sciatica, and haven’t appeared to suffer in the same way.

Unbeknown to Sarah, she was not being dramatic. She was actually showing signs of cauda equina syndrome (CES) – a rare but serious condition where nerves at the base of the spine become compressed. CES is a surgical emergency, and early diagnosis is critical. Delayed diagnosis can increase the risk of permanent nerve damage, loss of bladder and bowel control, and reduced mobility – potentially affecting sufferers in the long-term.

Failure to escalate

Over the next month, Sarah’s condition worsened. She struggled to move and care for herself appropriately, and eventually called her GP in tears from the pain. This finally prompted a discussion around CES symptoms, but even at this point, Sarah was given no urgent referral, and no scan was arranged.

Some days later, Sarah was seen by a physiotherapist, who recommended an urgent MRI. The urgency was not noted, and it took another 20 days before a routine MRI was performed.

By then, the damage had been done. The scan revealed a large L5/S1 disc extrusion compressing the cauda equina. She underwent emergency spinal surgery the following day and spent 10 days in hospital recovering.

A call to action

Sarah’s story is not just a personal tragedy – it is a call to action.

Her injury and long-term effects, could have been prevented. Sarah believes that if she had been informed of CES warning signs, or if healthcare professionals had recognised and acted on the symptoms earlier, the outcome may have been different. Instead, like many others, Sarah is now living with the long-term consequences of delayed care.

Expert support and signposting

Sarah is now under the guidance of our legal specialists, who understand the complexities of handling cauda equina cases. She is also connected to a number of charities – including Cauda Equina Champions – who have been pivotal in providing peer support and resource signposting, to help Sarah access the support she needs.

Our legal teams are currently working closely with medical experts to review her case, and give her the answers she so desperately needs.

Know the red flags of CES

Understanding the presenting symptoms of CES can be crucial for patients. Healthcare providers should be alive to this, but empowering patients to understand their own bodies and highlight when an issue doesn’t feel ok – can be key to safer and more effective treatment.

You are always within your rights to ask for a second opinion, or to be directive when you feel you need specific care from your GP or from other healthcare teams.

Signs of CES can include:

• Severe lower back pain with shooting leg pain
• Numbness or tingling in the saddle area
• Bladder or bowel changes (including incontinence or retention)
• Sexual dysfunction
• Weakness in the legs or altered reflexes

If you, or someone you know, experience these symptoms, it is important to seek medical attention and ask directly if it could be cauda equina syndrome.

Sarah is now sharing her story to raise awareness and advocate for more efficient processes, earlier imaging, and better education among both clinicians and patients.

We support Sarah in her advocacy journey, and share the sentiment that healthcare professionals should be alert to high-risk conditions, should escalate when necessary, and should listen carefully to their patients’ experience – who are the most well-informed individuals in understanding their own bodies.

Learn more about our spinal injury solicitors, and how we support individuals who have suffered cauda equina – that could have been avoided.